Archive for the ‘ANAL’ Category

Colon exam doesn’t finish the job

A new study is pushing a cut-rate version of the colonoscopy — and while it might save your insurance company big money, don’t count on it to save your life.

It’s called sigmoidoscopy, and it can cost as little as $250 versus $1,000 for a colonoscopy and anesthesia. Researchers say their analysis of studies involving hundreds of patients finds that this newer procedure is just as effective as colonoscopy at reducing deaths by colon cancer.

Both procedures use a camera on a tube inserted into your hindquarters, but that’s where the similarities end — because while colonoscopies involve a thorough examination of the entire colon, the bargain-basement version only looks at the lower third.

Hey, you’ve seen one part of the colon, you’ve seen it all, right?

Not on your life! Any gastroenterologist worth his scope will tell you that they often find polyps and other growths in the part of the colon skipped by the sigmoidoscopy.

An amateur, on the other hand, will miss polyps no matter where they grow… and that’s how we got this study.

You see, the researchers didn’t look at colonoscopies done here in the United States, where they’re performed by specialists such as gastroenterologists. Nope — all the patients in this review were overseas, where colonoscopies are done by general practitioners.

You’ve got a camera, I’ve got a tube — let’s have a rectal exam!

Take it from me — you know I have no great love of cancer screenings, and I’m against nearly all of them. But colonoscopies work, plain and simple, and they work so well there’s simply no reason to trust your hiney to any cheap, unproven alternatives — no matter how much the insurance companies might love them.

So forget sigmoidoscopies, virtual colonoscopies, and any other gimmick that comes along and get a plain old colonoscopy from a doctor with a proven track record.

HPV–known for causing cervical cancer–is

emerging as the leading cause of throat cancer in

men. Should they get the vaccine too?

Martin Duffy, a Boston consultant and economist, thought he just had a sore throat. When it persisted for months, he went to the doctor and learned there was a tumor on his tonsils.

Duffy, now 70, had none of the traditional risk factors for throat cancer. He doesn’t smoke, doesn’t drink and has run 40 Boston marathons. Instead, his cancer was caused by the human papilloma virus (HPV), which is sexually transmitted and a common cause of throat and mouth cancer.

HPV tumors have a better prognosis than those caused by too many years of booze and cigarettes. But Duffy “is in the unlucky 20%” whose cancer comes back–despite rounds of chemotherapy and radiation that melted 20 more pounds off a lean 150-pound frame. Now the cancer has spread throughout his throat, making eating and talking difficult. “I made my living as a public speaker,” he says. “Now I sound like Daffy Duck.” Duffy believes he has only a few months left. “How do you tell the people you love you love them?” he asks.

Most strains of the HPV virus are harmless, but persistent infections with two HPV strains cause 70% of the 12,000 cases of cervical cancers diagnosed annually in the U.S. Other forms of the sexually transmitted virus can cause penile and anal cancer, and genital warts. The HPV throat cancer connection has emerged in just the last few years and is so new that the government doesn’t track its incidence. Researchers believe it is transmitted via oral sex. But top researchers estimate that there are 11,300 HPV throat cancers each year in the U.S.–and the numbers are growing fast as people have been having more sexual partners since the 1960s. By 2015 there could be 20,000 cases. For more surprising discoveries about HPV, read here.

These big numbers have some top researchers arguing that drug makers should test whether HPV vaccines now used to prevent cervical cancer in women can also prevent throat infections in boys. Two vaccines, Gardasil from Merck ( MRK – news – people ) and Cervarix from GlaxoSmithKline ( GSK – news – people ), are approved for preventing cervical cancer. Gardasil is approved for use in boys only to prevent genital warts.

// Vaccinating boys could stop this meteoric increase in throat cancer. “Clearly, boys need to be vaccinated,” says Marshall Posner, the incoming medical director of head and neck cancer at Mt. Sinai Medical Center in New York. “I want my kids to be vaccinated. I don’t see a downside to these vaccines.”

There’s only one problem: The vaccine manufacturers aren’t terribly hot on the idea. GlaxoSmithKline says it has no plans to study throat cancer. It adds that it is “committed to providing a vaccine specifically designed to protect against cervical cancer in girls and young women.”

Merck, the maker of Gardasil, seemed more interested a couple of years ago. In 2008 it funded Maura Gillison, the Ohio State University researcher who established the HPV-throat-cancer link in 2000, to do a pilot study to show that test could reliably detect HPV infection in the throat. The pilot study was successful. By early 2009 Gillison says that a larger study of the vaccine in throat cancer looked close to being green lit.

But after Merck agreed to buy rival Schering-Plough ( SGP – news – people ) for $41 billion in March 2009, interest in a big study seemed to evaporate, Gillison says. In a statement, Merck says that “due to competing research and business priorities, we decided not to move ahead with an efficacy study at this time.”

The drug makers’ reticence probably stems from a fear that a throat-cancer vaccine would be hard to get approved. Papilloma viruses usually cause cancer slowly, causing pre-cancerous lesions that take many years to blossom into full-fledged malignant tumors. Papilloma viruses cause the horn-like growths in rabbits that probably gave rise to myths of “jackalopes” in the American West. In the cervix, early abnormal growths can be picked up with a diagnostic test, the Pap smear. Clinical trials of Gardasil and Cervarix took advantage of this, measuring the number of pre-cancerous growths prevented by the vaccines.

But there are no easy-to-detect pre-cancers in the throat. Adolescent boys would have to be followed for decades to to see if the vaccine prevented throat cancer, an unlikely scenario. Short of this, studies could only look at the prevention of HPV throat infections, not cancer or cancer precursors directly. Approving a vaccine for wide use based on this type of short-term data would require a leap of faith that the Food and Drug Administration might not be willing to take.

Top researchers say the federal government needs to step in and fund the long study if drug companies cannot be persuaded to do it themselves. “I’m sorry Merck decided not to do it,” says Posner. “But in the end, this is a federal responsibility. It’s a public health issue.”

For his part, Martin Duffy thinks that drug companies’ complacent attitude toward throat cancer would be different if more of their employees were in his situation. “It will change real fast,” he says, “if one of their executives comes down with this disease.”